Individual
EDWARD A WIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2422 LAKE AVE, ASHTABULA, OH 44004-4985
(440) 992-4422
Mailing address
2422 LAKE AVE, ASHTABULA, OH 44004-4985
(440) 992-4422
(440) 997-6507
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35069100
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0386014
—
OH
Enumeration date
04/27/2006
Last updated
10/07/2025
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